Care during labor and birth for the prevention of intrapartum-related neonatal deaths : a systematic review and Delphi estimation of mortality effect

Show simple item record Lee, Anne C.C. Cousens, Simon Darmstadt, Gary L. Blencowe, Hannah Pattinson, Robert Clive Moran, Neil F. Hofmeyr, G. Justus Haws, Rachel A. Bhutta, Shereen Zulfiqar Lawn, Joy E.
dc.contributor.other Pattinson, Bob 2011-05-05T09:17:16Z 2011-05-05T09:17:16Z 2011-04
dc.description Additional file 1: is an excel sheet that contains fives sheets each of which has a table presenting extraction criteria and outputs for studies used in the meta-analysis. Additional File 2: is pdf document that contains the Delphi form used in the Delphi process and as well as background information and appendices that were provided to the Delphi participants. en_US
dc.description.abstract BACKGROUND: Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). METHODS: We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate causespecific mortality effects. RESULTS: We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 metaanalyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. CONCLUSION: Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation include varying definitions of obstetric packages and inconsistent measurement of mortality outcomes. Thus, the LiST effect estimates for skilled birth and emergency obstetric care were based on expert opinion. Using LiST modelling, universal coverage of comprehensive obstetric care could avert 591,000 intrapartum-related neonatal deaths each year. Investment in childbirth care packages should be a priority and accompanied by implementation research and further evaluation of intervention impact and cost. en_US
dc.description.sponsorship This work was supported by the Bill and Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US. en_US
dc.identifier.citation Lee et al.: Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect. BMC Public Health 2011 11 (Suppl 3):S10. DOI: 10.1186/1471-2458-11-S3-S10 en_US
dc.identifier.issn 1471-2458
dc.identifier.other 10.1186/1471-2458-11-S3-S10
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights © 2011 Lee et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.subject Care during labor and birth en_US
dc.subject Neonatal mortality en_US
dc.subject Intrapartum-related neonatal deaths en_US
dc.subject.lcsh Childbirth -- South Africa
dc.title Care during labor and birth for the prevention of intrapartum-related neonatal deaths : a systematic review and Delphi estimation of mortality effect en_US
dc.type Article en_US

Files in this item

This item appears in the following Collection(s)

Show simple item record